Definition and Overview
Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic non-spinning dizziness, unsteadiness, and visual sensitivity present on most days for 3 or more months [1].
PPPD is the most common cause of chronic subjective dizziness, typically triggered by an acute vestibular event (BPPV, vestibular neuritis), migraine, or panic attack that resolves but leaves persistent symptoms due to maladaptive central processing [2].
Diagnostic Criteria (Barany Society)
- Dizziness, unsteadiness, or non-spinning vertigo on most days for 3+ months
- Symptoms exacerbated by upright posture, active or passive motion, and complex visual stimulation
- Preceded by an acute condition causing vestibular symptoms or balance disturbance
- Symptoms cause significant distress or functional impairment
- Not better explained by another disease or disorder
Pathophysiology
After an acute vestibular event, normal compensatory strategies (increased visual dependence, stiffened postural control) persist maladaptively. High-order cortical processing of vestibular-visual-somatosensory signals remains altered [3].
Treatment
Vestibular rehabilitation therapy (VRT) is the cornerstone, gradually desensitizing the patient to provocative stimuli [4]. SSRIs (sertraline 50-200 mg, escitalopram 10-20 mg) reduce dizziness severity. CBT addresses avoidance behaviors and anxiety. Prognosis improves significantly with early, combined treatment.